A child's itching, sneezing and wheezing should not be ignored as they could be symptoms of allergy. It is important to understand how allergies are diagnosed and managed, according to consultant clinical immunologist and allergis t Dr Amir HA Latiff, who is the president of the Malaysian Society of Allergy & Immunology (MSA I).
He answers some frequently asked questions on allergies.
It is estimated that by the year 2020, 50% of Malaysians will be suffering from some form of allergy. How would you rate the incidence of allergy among Malaysian kids now?
In Malaysia, the incidence of school-going children with allergies is 10-15% at the turn of the 21st century, and has probably increased over the last decade.
How can parents determine the risk of allergy in their children?
Although there are other methods such as blood tests, family history (particularly parental history of allergy) remains a simple method of assessing the risk. Studies have shown that children may develop allergy if their parents have allergies.
Thus, if both parents have allergies, there is a 50-80% chance of their children having allergy. But if only one parent has allergies, this risk goes down to 20-40%. However, there is still a risk of up to 15% for a child to develop allergy when neither parents have allergies.
If a mother suspects that her child has some form of allergy, are there any specific tests that a doctor can perform to identify the cause? If yes, what are the tests?
Whenever an allergic disease is suspected, it is best to diagnose with relevant tests. We should not simply assume that the child is allergic to a certain substance e.g. a certain food, and omit that food without performing specific tests because this may cause the child to have an unbalanced diet and lose out on nutrients from the wrongly-avoided food.
The specific tests basically test for an immediate-type (immunoglobulin E, or IgE antibodies) allergy. They detect the presence of specific IgE and are performed either via blood or skin prick tests (SPT).
What are the common forms of allergy suffered by young Malaysian children?
Allergy is one disease with many presentations, such as atopic eczema (or atopic dermatitis), allergic rhinitis, allergic asthma as well as food allergy. Young Malaysian children may have eczema, which tends to be the earliest presentation and it may be associated with food allergy, which has a prevalence of 5-10% in children. The most common food allergy in infancy and childhood is allergy to cow’s milk protein. While atopic eczema and food allergy may eventually disappear in most children before starting primary school, other allergic diseases may appear, such as asthma and rhinitis.
This progression is commonly termed as “allergy march,” and can occur among Malaysian children. It is also likely that while the symptoms of an allergy are “outgrown,” the allergic mechanism may persist into adulthood.
And how should these allergic conditions be managed?
Once an allergic condition is confirmed, avoidance becomes an important step. However, this may not be easily carried out in our daily life. Depending on the type of allergic condition, medications would include antihistamines, intranasal and/or inhaled corticosteroids, inhaled bronchodilators and in a severe life-threatening allergic reaction (anaphylaxis), self-injectable adrenaline is used.
Diet-wise, a healthy and balanced one is required. For those who need to avoid certain foods, it is important to confirm the source of the allergy through specific tests. Regular exercise such as swimming and running are recommended. In general, if one has allergies, one is still able to exercise, but refrain from overdoing it. And do not exercise when ill. Discuss with your child’s physician / paediatrician before starting an exercise programme.
What are the proactive steps that parents can take to prevent allergy from the very beginning?
As there is no known cure for allergy, once an allergy is confirmed, avoidance of the offending substance is important. Strategies to reduce allergy have been researched but most are not significant. Hence, allergy prevention remains a major challenge. In addition, one form of allergy may progress to another via the “allergy march.”
Nevertheless, there is some evidence that for infants at risk of allergy, hydrolysed milk could be beneficial in preventing atopic eczema from developing during infancy. Other strategies include the use of probiotics, prebiotics, polyunsaturated fatty acids and vitamin D. However, more research is required to determine the benefits of using these supplements in allergy prevention.
Article courtesy of the Malaysian Society of Allergy & Immunology. For more details or information on allergy, visit allergymsai.org or xyzofallergy.org. Malaysian Society of Allergy and Immunology (MSAI) was officially launched in 1998 to provide better patient care and quality of life to the sufferers of allergic diseases and their families. Since then, the society has been actively involved in disseminating information on immune-mediated diseases, particularly allergy and primary immunodeficiency diseases to healthcare professionals and the public. It also keeps abreast of new knowledge and findings in all aspects of basic sciences and treatment of these diseases.
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